Characteristics of the subjects:
In an attempt to understand the different pain levels caused by e-learning, the questionnaires were distributed to several faculties at AN-Najah national university. A total of 385 students were included in the study, the mean age for study participants was 19.91 (SD = 9.8). The sample included 148 men (38.4%) and 237 women (61.6%) (table S1). Most of the participating students were from the faculty of medicine and health sciences (29.6 %), followed by faculty of engineering and information technology (28.3%), faculty of educational sciences and teacher training (20%), faculty of Islamic law (6.8%), faculty of economic and financial sciences (5.5%), faculty of science (4.9%). The participation of students from faculties other than the mentioned were minimum (Table 1). Concerning the handedness of the subjects, around 90.6% of the subjects were right handedness, while 4.2% had left handedness and 5.2% can use both of their hands (Table S2).
Participants faculties
|
Frequency
|
Percentage
|
Faculty of Medicine and health sciences
|
114
|
29.6
|
Faculty of Agriculture and Veterinary Medicine
|
1
|
.3
|
Faculty of Economics and Social Studies
|
21
|
5.5
|
Faculty of Educational Sciences and Teachers' Training
|
77
|
20.0
|
Faculty of Engineering and Information Technology
|
109
|
28.3
|
Faculty of Fine Arts
|
2
|
.5
|
Faculty of Graduate Studies
|
3
|
.8
|
Faculty of Humanities
|
7
|
1.8
|
Faculty of Islamic Law
|
26
|
6.8
|
Faculty of Law
|
6
|
1.6
|
Faculty of Science
|
19
|
4.9
|
Total
|
385
|
100.0
|
Table 1. Participants faculties
Patterns of laptop, computer or tablet use:
When questioning the pattern of laptop and tablet usage, our analysis showed that (1.3%) of the participants never using desktop / laptop, 46.8% of the participants used the desktop/laptop daily, 48.8% of them used the computer from (4-6 days), while 3.1% of them used it from 1-3 days (table S3).
In addition, the average daily usage of laptop and tablets was about 8.2+- 4.2hours, from theses hours around 5.9 +- 3.5 were for e-learning use (table S4). Detailed analysis showed that the main purpose of using the desktop / laptop or tablet device was in favor of multiple usage with percent of (42.3%), then for the studying with percent of (35.1%), followed by for watching videos with percent of (8.6%) and for following social media with percent of (7.8%), and for working with percent of (3.4%) and just for gaming with percent of (1.8%) and finally for texting with percent of (1%). Chi2 value = 469.855 and its significant at level of < 0.001 and the variance was in favor of multiple purposes (table 2).
purposes
|
Frequency
|
Percentage
|
Chi2
|
df
|
Sig.
|
Studying
|
135
|
35.1
|
469.855a
|
6
|
0.000*
|
Texting
|
4
|
1.0
|
Working
|
13
|
3.4
|
Gaming
|
7
|
1.8
|
Social media
|
30
|
7.8
|
Watching videos
|
33
|
8.6
|
Multiple purposes
|
163
|
42.3
|
Total
|
385
|
100.0
|
Table 2. The purpose of using your desktop / laptop or tablet device. Multiple usage was counted if the participants used the device for several reasons including Studying
Further analysis for different gender usage for laptops and tablet in e-learning showed that female tend to have higher hours than males, 6.38 compared to 5.09, p <0.001.
Upon analysis of the most common sitting position during desktop/laptop usage, 49.9 % of the participants that they were Sitting on the chair with the Spine slopping forward. However, 17.1 % of the participants said that they usually sit on the chair with straight spine, and 14.3% of the participants said that they usually sit with supine position. In addition, 12.7%, 3.6%, and 2.3% of the participants said that they sit on the ground with supine sloping forward, Spine sloping back, and straight supine, respectively. Chi2 = (346.268 and its significant at level of < 0.001 and the variance was in favor of sitting position on the chair with back slopping forward (table 3).
|
Frequency
|
Percentage
|
Chi2
|
df
|
Sig.
|
Sitting on the ground (The Spine sloping forward)
|
49
|
12.7
|
346.268
|
5
|
0.000*
|
Sitting on the ground (The Spine is straight)
|
9
|
2.3
|
Sitting on the ground (The Spine sloping back)
|
14
|
3.6
|
Sitting on the chair (The Spine slopping forward)
|
192
|
49.9
|
Sitting position on the chair (The spine is straight)
|
66
|
17.1
|
Supine position (Lying down)
|
55
|
14.3
|
Total
|
385
|
100.0
|
Table 3. The most frequent position of the participants during desktop / laptop or tablet device usage
Furthermore, there was statistical significance in comparing sitting positions for both genders although both male (44.5%) and female (53.2%) students reported the highest percentage in sitting on chair with supine bent forward (table S5).
Pain Experience during desktop/laptop usage
Several questions in the questionnaire were asked about some physical pain that could be associated with desktop/laptop usage. Our analysis showed that 48.3 % of the study participants had an earlier experience of neck, back and shoulder pain and that the pain was worst after e-learning. However, 8.6 % of the participants said that the pain they had in their neck, back or shoulder didn’t change after e-leaning. In addition, 43.1% of the participants said that they have never had any pain before. Chi2 value = 107.787 and its significant at level <0.01 and the variance was in favor of the study sample from the first category. (Table 4).
|
Frequency
|
Percentage
|
Chi2
|
df
|
Sig.
|
Yes, now it is worst after using e-learning
|
186
|
48.3
|
107.787a
|
2
|
0.00*
|
Yes, same as now
|
33
|
8.6
|
No
|
166
|
43.1
|
Total
|
385
|
100.0
|
Table 4. Did you experience neck, back and shoulder pain before?
When questioning the pain site, our results showed that 32.2 % of the participants had neck pain, 15.3 % had right shoulder pain, 20% had left shoulder pain, 15.1% had back pain, while 17.4 % of the participants didn’t have pain at all (table S6).
Regarding the pain frequency among the participants, 5.2% of the participants had pain in one day per week, 14.3% had pain 2 days per week, 17.7%had pain 3 days per week. 15.8%, 10.4 % 3.6% and 15.6% had pain in 4, 5,6 and 7 days per week, respectively. On the other hand,17.4% of the participants said they don’t have any pain, noting that Chi2 value was (64.974) and its significant at level < 0.001 (table 5).
|
Frequency
|
Percentage
|
Chi2
|
df
|
Sig.
|
1 day
|
20
|
5.2
|
64.974
|
7
|
0.000*
|
2 days
|
55
|
14.3
|
3 days
|
68
|
17.7
|
4 days
|
61
|
15.8
|
5 days
|
40
|
10.4
|
6 days
|
14
|
3.6
|
7days
|
60
|
15.6
|
I do not have pain
|
67
|
17.4
|
Total
|
385
|
100.0
|
Table 5. the pain frequency (in days per week)
Further analysis for the exact duration of the pain showed most participants had pain for 1-6 hours per day. Chi2 value = 453.784 and its significant at level <0.001 and the variance was in favor of pain duration (1-6 hours) (table 6).
|
Frequency
|
Percentage
|
Chi2
|
df
|
Sig.
|
No pain
|
67
|
17.4
|
453.784
|
3
|
0.000*
|
1 – 6 hours
|
274
|
71.2
|
7-12 hours
|
32
|
8.3
|
More than 12 hours
|
12
|
3.1
|
Total
|
385
|
100.0
|
Table 6. The pain duration (in hours)
In our study, we also questioned the most common timing of the pain. Our results showed that the participants most common timing of the pain was at the night (36.1%), while 9.9% of the participants had pain in the morning, and 13.8 % had pain in the afternoon, and 22.9% had pain throughout the day. Chi2 value was (77.688) and its significant at level <0.001 (table 7).
|
Frequency
|
Percentage
|
Chi2
|
df
|
Sig.
|
In the morning
|
38
|
9.9
|
77.688
|
4
|
0.000*
|
At night
|
139
|
36.1
|
In the Afternoon
|
53
|
13.8
|
Throughout the day
|
88
|
22.9
|
I do not have pain
|
67
|
17.4
|
Total
|
385
|
100.0
|
Table 7. Most common timing of the pain
On the other hand, analysis of the pain severity was assessed using a 10-degree scale. Chi2 value confirms that there is a variance between the pain's severity among the participants and the degrees were ranged between 0 to 10 but the most pains severity was from degree (2 – 8), while (9 – 10) degrees were less than other degrees (table 8).
|
Frequency
|
Percentage
|
Chi2
|
df
|
Sig.
|
.00
|
67
|
17.4
|
108.325
|
9
|
0.000*
|
2.00
|
34
|
8.8
|
3.00
|
53
|
13.8
|
4.00
|
49
|
12.7
|
5.00
|
47
|
12.2
|
6.00
|
62
|
16.1
|
7.00
|
40
|
10.4
|
8.00
|
20
|
5.2
|
9.00
|
6
|
1.6
|
10.00
|
7
|
1.8
|
Total
|
385
|
100.0
|
Table 8. The pain's severity on scale of 10, Knowing that 10 means the strongest pain ever experienced
To evaluate the effect of the pain associated with desktop/laptop use on the daily activity of the participants, we asked them to assess their ability to perform several daily functions. Our results showed that the mean of difficulties found in case of neck and back is 1.79 / 4.00 +- 0.65 which is equivalent to low level difficulty on a scale of no, low, moderate, and severe difficulty. However, walk for several miles was ranked first with the mean of 2.02 +- 0.99 and it is of a moderate level on the difficulty scale. In addition, standing up for 20 to 30 minutes ranked second with mean of 1.92 +- 0.94 and it is of low level on the difficulty scale. On the other hand, walking for short distances was ranked last with mean of 1.41+-0.67 which is also equivalent to low level on the difficulty scale (table 9).
|
Difficulties
|
Mean
|
Std. Deviation
|
Rank
|
Level
|
1
|
Get out of bed
|
1.65
|
0.80
|
7
|
Low
|
2
|
Sleep through the night
|
1.89
|
0.89
|
3
|
Low
|
3
|
Turnover in bed
|
1.81
|
0.92
|
5
|
Low
|
4
|
Stand up for 20 to 30 minutes
|
1.92
|
0.94
|
2
|
Low
|
5
|
Bend over
|
1.87
|
0.92
|
4
|
Low
|
6
|
Carry two bags of groceries
|
1.77
|
0.84
|
6
|
Low
|
7
|
Walk for short distances
|
1.41
|
0.67
|
8
|
Low
|
8
|
Walk for several miles
|
2.02
|
0.99
|
1
|
Moderate
|
|
Total
|
1.79
|
0.65
|
|
Low
|
Table 9. The level of difficulties finds in descending order.
Pain experience during e-learning
Upon analyzing predictors for pain severity, we found that the duration of desktop/laptop usage for e-learning was significantly associated with pain duration (p <0.01) with Pearson correlation of 0.146 for duration of use (Fig 1).
In addition, our results showed a significant correlation between the duration of desktop/laptop use for e-learning and the severity of the pain among participants (p<0.001) with Pearson correlation of 0.199 for duration of use (fig 2).
Furthermore, our study showed that duration of desktop/laptop usage for e-learning was correlated significantly with increased difficulty of getting out of bed (p<0.001, Fig. 3A), sleeping through the night (p<0.01, Fig. 3B), turning over in bed (p<0.001, Fig 3C), standing for 20-30 min (p<0.5, Fig. 3D), bending over (p<0.01, Fig. 3E) and walking for several miles (p<0.001, Fig. 3F) with Pearson correlation of 0.177, 0.169, 0.233, 0.129, 0.134 and 0.184, respectively.
When comparing the duration of desktop/ laptop or tablet use with gender, there was a significant correlation between both factors (p<0.001) with Person correlation of 0.197 (fig. 4A). Moreover, a significant correlation was also detected between the gender of the participants and the severity of the pain (p<0.001) with Person correlation of 0.267 (fig. 4B).